Shifting sands in Saudi Arabian healthcare system towards value-based care: navigating the changing landscape

The KSA's healthcare system is undergoing substantial transformation under Vision 2030, with a strategic shift toward value-based healthcare (VBHC). This perspective paper examines the national reform initiatives and implementation readiness using five interrelated domains: data interoperability and governance, health technology assessment (HTA) capacity and availability of local data, policy fragmentation across high-cost therapeutic areas, operational burden of managed entry and risk-sharing agreements, and equity and stakeholder trust. Evidence was synthesized from peer-reviewed literature, policy documents, and institutional sources from the Saudi Ministry of Health. The analysis highlights progress in digital health integration, formulary modernization, pharmacoeconomic evaluation, real-world data infrastructure, and expanding use of value-linked reimbursement mechanisms. However, persistent challenges include fragmented digital systems, limited technical capacity for advanced HTA, heterogeneous policy implementation in specialized therapeutic areas, administrative complexity associated with performance-based agreements, and ongoing equity and trust considerations. Emerging methodological advances, including cost-effectiveness thresholds, development of multi-criteria decision analysis frameworks, and establishment of a Saudi-specific EQ-5D-5L valuation, strengthen the foundation for VBHC implementation. In this paper, we have recommended an implementation-oriented assessment of system enablers and constraints and identifies priority areas to support scalable, evidence-based, and sustainable adoption of VBHC in the KSA.